Archived: Queens Park Court Care Home

This inspection was carried out to assess what the provider had done in response to the action we had told them to take following our last inspection. This was in relation to the safe management of medicines.

This is a summary of what we found-

Is the service safe?

We found the service was not safe because people were not protected against the risks associated with medicines. We found that there had been some improvements made to the way medicines were handled and managed in the service since our previous inspection but there were still actions that the provider needed to take to ensure that people received their medicines safely.

You can see our judgements on the front page of this report.

This inspection took place to follow up on further information of concern received and to check if any improvements had been made.

We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found;

Is the service safe?

At this inspection we found the provider was continuing to fail in this area. The service still did not have a full complement of trained, experienced and skilled permanent staff.

There were insufficient numbers of senior care staff to administer medication in a timely manner and people were not receiving their medication according to the prescribed times, which could have had an impact on their health and wellbeing. Required improvements had not been made since our last inspection in relation to the safe handling of medication practices and there continued to be serious failings which were putting people at potential risk. Whilst records showed that staff responsible for the administration of medication had received a form of E learning training and assessment of competence; we found this was not sufficient to protect people from risks associated with medicine management and we still found errors occurring. We told the provider they must put suitable arrangements in place to meet the requirements of the law.

Prior to this inspection we received information of concern telling us that staff were not carrying out moving and handling practices correctly and that they were not using the correct type and size of sling when moving people with a hoist. Whilst we saw the provider had purchased new and additional hoist slings we found that not all staff had received training, or regular training update, in moving and handling practices.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLs) which applies to care homes.

The service did not have appropriate arrangements in place that complied with the requirements of the Mental Capacity Act (MCA) 2005, DoLs and associated Codes of Practice. People's capacity, needs and abilities were not fully considered within people's assessment and care planning arrangements. Where people were unable to make day to day or significant decisions, we saw that MCA assessments had not been completed and reviewed. Where it was necessary, best interest decisions taken on behalf of people who did not have capacity had not been taken through formal assessment with relevant healthcare professionals, in accordance with legal requirements.

Is the service effective?

Since our last inspection little progress had been made in reviewing and updating people's care plans and therefore staff were not guided by clear and current care planning arrangements to meet people's needs.

Staff had not received appropriate training, professional development and support to enable them to carry out their role effectively and safely.

Is the service caring?

We continued to find that people living in the service with full mental capacity had better experiences with choice, independence and dignity than those who have lesser capacity to express their needs.

The staff, at the time of our inspection, showed commitment and compassion towards the people they were supporting. However staffing numbers were not sufficient to ensure people were enabled to maintain independence and access the wider community. One staff member supported a person to go to the local shop but this was only possible by doing it in their own time, during their break.

Is the service responsive?

This inspection found that the provider had not responded effectively and promptly to our previous concerns and very little improvement had been made to ensure outcomes for people improved.

In failing to address the concerns we raised robustly, we were not confident that the provider was committed to ensuring the service was responding appropriately to people's needs and in line with the services statement of purpose.

Is the service well-led?

Management and quality assurance systems were not robust. They were not driving improvement effectively or at the correct pace to protect people against the risks of inappropriate or unsafe care.

Risk and improvement continued to be monitored by the local authority who commission care from the service. They were identifying and acting on issues for people that were repetitive and raised safeguard concerns. The provider and management were not working in partnership with the local authority and offers of assistance, particularly in relation to staffing support, had been declined by the provider.

This is a summary of what we found;

Is the service safe?

At this inspection we found that the provider was continuing to fail in this area. The service did not have a full complement of staff and relied heavily on temporary agency staff. We found discrepancies in the assessment of people's dependency levels together with shortfalls in numbers of staff deployed to each unit. We saw that there were insufficient staffing levels to meet people's needs at all times and deliver safe and appropriate care. We observed incidents where people's dignity, safety and welfare were compromised due to the lack of staff.

One relative told us: 'I often see people left unsupervised, they are calling out and trying to get up, there is just not enough staff to ensure their safety. Most often now the units are staffed by agency and they do not know the people they are looking after.'

Is the service effective?

At the time of our inspection the staff team of six was made up of three temporary agency support workers and a new support worker in their second week. From our observations, we could see that staff did not know the needs of people very well and care plans were not used properly to support them in the delivery of people's care.

People living in the home with full mental capacity had better experiences with choice, independence and dignity than those who have lesser capacity to express their needs. This means that many people did not always experience care, treatment and support that met their individual needs, protected their rights and promoted their well-being.

Is the service caring?

We saw that the staff on duty mostly interacted with people living in the service in a caring and respectful way. We saw that care was rushed and people's needs were not always met promptly, safely and in a dignified manner. Temporary agency staff did not know people well. People who were able to speak with us about their experiences and two visiting relatives told us that staff were mostly caring but there were not enough of them. One relative told us: 'Staff are running around all over the place, they are so busy. Staff are very caring but there is not enough to enable care to be delivered properly.'

Is the service responsive?

People living with dementia were not provided with meaningful activity and interaction that would promote their wellbeing. This was mainly due to one staff member supporting up to ten people and not being able to spend quality time with individuals. Therefore the service was not responsive and there was a task led approach to providing care and support.

Is the service well-led?

Systems had been introduced to identify risk and monitor safety with regards to health and safety and the environment that people lived in, and others worked in. However, there were no systems in place that were managed effectively to properly identify failings in the quality and safety of care provision. The provider had not considered our concerns detailed in our last inspection report relating to non-compliance with regulation.

The service has not had consistent management and leadership and has been without a registered manager in place for over one year. This may form part of the reason why compliance with regulations and improvements has not been sustained.

The new manager has been in post since the beginning of February 2014. Whist we recognise the manager is experienced we believe they require more support from the provider to enable them to address the improvements required and lead the service effectively.

We carried out a responsive inspection and through our observations, discussions with the manager, staff and visiting health professionals we found that there were insufficient numbers of suitably qualified, skilled and experienced staff employed to meet the needs of people using the service and safeguard their health, safety and wellbeing. Many people living at Queens Park Court had varying levels of dementia related needs and were unable to share their experiences with us.

A relative told us that staff were kind and caring and very busy. They told us that basic needs were met. However other things were overlooked which would enhance wellbeing such as ensuring hearing aids were worn and working properly and providing opportunities for one-to-one engagement and stimulation.

One person we spoke with told us they were very happy with the service.

On the 24 May 2013 we served two warning notices on the provider outlining the non-compliance and where improvements needed to be made. We told the provider that they needed to be compliant by the 14 August 2013.

We visited Queens Park Court again on the 22 August 2013, to check compliance with the warning notices. We found that the provider had taken steps to improve the care and welfare for the people living at the home in order to meet their needs and had made improvements to the assessment and monitoring of the quality of service provision.

We visited Queens Park Court again on the 10 July 2013, to check compliance with the warning notice. We found that the provider had taken steps to improve the staffing at the home in order to meet the needs of the people living there.

The provider submitted an action plan that outlined the steps they were going to take to achieve compliance which they said would be done by the 31 March 2013.

We visited Queen Park Court Care Home again in April 2013 to review compliance against these regulations. We found that the provider remained non-compliant with regard to all four regulations.

We spoke to the people living in the home. Their comments included: "The staff are good with your privacy and dignity.' Another person told us: 'My nails need cutting but the lady who does them is off and has been for some while, mine are a mess, we are all stuck with long nails.' One person told us 'There is nothing to do, no-one has anything to say to you and it feels awkward, so I stay in my room' and another person told us: "Occasionally the staff chat to you but they really don't have the time' and 'You can wait a mighty long time for staff sometimes.' One person told us: 'I have never been asked if I am happy here or if I want anything to change.'

We found that people living in the home cannot be fully assured that they will have choices in their day to day lives or that their independence will be promoted. People living in the home with full mental capacity had better experiences with choice, independence and dignity than those who have lesser capacity to express their needs.

We found that shortfalls in the planning and delivery of care meant that people living in the home may not have all their care needs met and met in an individual way.

When we spoke to the people living at the home they told us that they felt safe and well cared for and we found that the provider had suitable arrangements in place to safeguard people against abuse.

When we reviewed staffing arrangements we found that discrepancies in the assessment of dependency together with shortfalls in staff deployment, at key times meant that people living in the home may not have sufficient staff to meet their needs. We also found that whilst people living at the home had recently been asked for feedback on the services they received, overall the provider did not have a fully effective system in place to asses and monitor the quality of the services provided at this home.